Corticosteroid induced osteoporosis guidelines

La DMD es una enfermedad hereditaria, que afecta a cerca de uno en 3500 a uno en 6000 varones recién nacidos. La DMD causa debilidad muscular, que empeora con la edad. La debilidad muscular es generalizada y afecta el movimiento, el aparato digestivo, la respiración y el corazón. El patrón de debilidad afecta principalmente a los músculos cerca del tronco, alrededor del hombro y en la cadera. Si no se trata, la DMD lleva a la muerte antes de los 30 años por las complicaciones respiratorias y cardíacas. Los niños con DMD a menudo muestran los primeros signos de esta enfermedad antes de comenzar la escuela. Si no se trata, pierden la capacidad de caminar a la edad de 13 años y se hace necesario usar una silla de ruedas. La DMD es incurable, pero los corticosteroides retrasan el daño muscular y les permiten a los niños caminar por más tiempo. Los niños con DMD también tienden a presentar huesos débiles por la debilidad muscular y la reducción de la movilidad.

Corticosteroid-induced osteoporosis is the leading cause of secondary osteoporosis and a significant cause of morbidity in both men and women. Long-term use of even low-dose corticosteroids has been associated with increased risk of bone loss. Recent large randomized controlled trials have generated new knowledge on treatment strategies for patients with corticosteroid-induced osteoporosis. However, the majority of individuals receiving corticosteroids are not receiving prophylaxis for osteoporosis. Calcium and vitamin D should be recommended to patients initiating therapy with corticosteroids (and should be adequate for those receiving corticosteroids for less than 3 months). For those receiving corticosteroids for greater than 3 months, bisphosphonates are the therapy of choice, with both alendronate (alendronic acid) and risedronate (risedronic acid) approved by the US FDA for use in this indication. Calcitonin can be considered a second-line agent and should be reserved for patients who are intolerant of bisphosphonates or who are experiencing pain from a vertebral fracture. Hormone replacement therapy or testosterone therapy may be offered to those individuals on long-term corticosteroid treatment who are hypogonadal. Teriparatide (recombinant human parathyroid hormone 1-34) shows promise as a future anabolic agent for the prevention and treatment of patients with corticosteroid-induced osteoporosis.

Corticosteroid induced osteoporosis guidelines

corticosteroid induced osteoporosis guidelines

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